Different Day, Same Shit.

As of this moment, yours truly is doing his best to navigate through the Healthcare.gov site, but between the constant waiting and error messages (how can your account get locked after you tried logging in for the first time?), it's not going well. The deadline itself is being pushed back for those who got started on their applications. More to come later on.

Health insurance. It's something you might not think you need, until you need it. Then you wish you had it. Or perhaps you want it but simply can't afford it. Either way, it's a critical necessity, despite what many people think to the contrary.

Confused over the ongoing fight over Obamacare? What to know exactly what the hell's going on and how it could possibly affect you? Then take a seat and read on as yours truly attempts to hash out an explanation. Keep in mind this explanation is rather simple and to the point, so there might be a few technical things and other nuances that got thrown out of the boat:

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To better understand Obamacare and people's reactions to it across the political spectrum, it's important to understand how health insurance in works, not just in general, but in this country and elsewhere.

How the hell does this health insurance stuff work?

Health insurance is essentially a large group of recipients paying into a pool of money. When a recipient needs medical care, whether it's preventative care (monthly checkups, etc.) or emergency care, money is taken from the pool to pay for their expenses. Since health insurance works on the principle of there being more healthy people than sick, there's always a relatively large pool of money to tap into.

What's up with insurance companies and their coverages and why does the shit cost so much?

The vast majority of people in the United States rely on private health insurance providers. Here, most folks pay either a (steep) monthly or annual premium out of their own wallets or have a portion of their paycheck deducted to pay for a healthcare plan shared with their coworkers. As a result, there are thousands of different pools that people pay into for their coverage, some more expensive than others, all of them with their own rules and guidelines.

Private health insurance providers also have plenty of leeway regarding who gets to dip into the pool and who doesn't. On the face of it, you can't blame them - thousands of scattered insurance pools are more vulnerable to getting syphoned dry by people with a boatload of health risk factors. That means smokers, the morbidly obese, diabetics and others with a slew of health problems are either told to pay ridiculous amounts of money or get tossed out of the pool. Got a preexisting condition? Good luck. Insurance companies also have their profits to think of. These profits usually average around three percent, but that's been bumped up to around eight percent as of late, accompanied by rising premiums. Ordinary Joes and Janes who are the perfect image of health are forced to pay much more than they should, just to cover both profit margins and the folks who need to dip into the money pool.

And that dip's a relatively deep one, too. Thanks to the high cost of health insurance, approximately 48 million Americans, many of whom are on the wrong side of the poverty line, simply go without. That means they go without preventative care unless they're lucky enough to either pay for it out of pocket or land a job that gives them some form of coverage. A lack of preventative care means that potential health issues go undetected, usually for years at a time. In the end, most people won't go to the hospital until the proverbial shit hits the fan and they need a trip to the emergency room. Emergency room care costs big bucks. So does surgery and treatment for issues that could have been nipped in the bud early on (like, say, cancer). At any rate, the overall cost of healthcare skyrockets.

My health insurance provider told me to go fuck myself with a rusty pipe when I got sick. What's up with that?

Of course, insurance companies absolutely hate paying out hundreds of thousands of dollars to cover medical expenses, hence they'll find any excuse in the book (and a few that don't exist) to unceremoniously drop paying recipients if they dip too deep into the money pool too often. In fact, many companies have panels that review medical requests before signing off on them and those that don't meet their particular criteria are often denied. They'll also stiff hospitals on the bill, which is why they routinely charge insurance companies much more than necessary just in case they get shortchanged. The fight between hospitals, private insurers and their customers can easily be replicated by laying down in the middle of a pack of starving pitbulls with a bloody steak on your face.

Did you know that many private health insurance providers have a network of select hospitals their insured customers can only go to if they're to expect continuing coverage? Stray outside of that network and be prepared to take that second mortgage out on your soul.

So what's this single-payer shit I keep hearing about?

On the other hand, there's single-payer healthcare, commonly known as socialized or universal healthcare. With this type of coverage, there's one money pool (usually administered by a government agency) and every citizen in the country it's enacted in pays into that pool, usually through taxes or mandated fees. Except for the desperately poor, who are given a break and are still allowed to draw out of that pool. The all-inclusive nature of the single-payer system means that 1)there's only one huge pool to pay into and draw out of, therefore 2)there's always enough money in the pool to cover every paying recipient, plus those who aren't able to pay and 3)recipients wind up paying far less in premiums than they had to with private coverage.

Since it's the government footing the bill, hospitals and healthcare providers can rest easier knowing that they'll pay. And since it's the government's dime, the government itself can dictate exactly how much it's willing to pay said hospitals, thereby lowering overall costs.

In short, single-payer saves money. Instead of ignoring that stabbing, throbbing pain in the side for months until you get rushed to the emergency room for a $10k stay and a $100k emergency surgery, your single-payer coverage allows you to go to the doctor to see what that pain's all about. Thanks to that huge pool effectively subsidizing your doctor's visit, the $1k in preventative care costs you zero or damn near close to it.

Other, more respectable countries throughout the world have some form of universal health coverage, provided through public funding sourced from taxes and fees. Some countries combine their publicly funded healthcare with optional coverage from a private health insurer. Other countries leave their healthcare coverage up to these private companies, but strongly regulate how much they can charge and even provide significantly low-cost (or free) health insurance coverage. This is essentially the route that Obamacare's going (but more on that in a minute).

Wait...doesn't that sound an awful lot like Medicare/Medicaid?

It does, doesn't it? In fact, some would say that a single-payer system in America would just be Medicare for All.* As it stands, Medicare is strictly for those over age 65 or anyone with disabilities. Medicaid is for people who are too poor to purchase private coverage on their own - mainly families, women and children. Unfortunately, the eligibility requirements vary among each state. Each year, the federal government disburses a set amount of money to individual states for their Medicare and Medicaid programs. Some states are more generous with the proceeds than others.

Okay...Obamacare.

Once upon a time, President Barack Obama foolishly attempted to bring single-payer healthcare to these United States. The measure was dragged behind the Capitol by conservative legislators and unceremoniously double-tapped in the head. The End.

Said legislators dressed the corpse in a new suit, took out the stuff they didn't really like (like the whole single-payer thing), slapped on a sticker reading "private insurance-friendly" and reintroduced it as the Affordable Care Act, which Congress passed and the president eventually signed in March 2010.

The simplest explanation of "Obamacare" (which is what opponents called it whenever they wanted to disparage it - the name kinda stuck after a while) is that it's a stop-gap between private insurance and single-payer insurance. In other words, all of the private healthcare providers are now part of a regulated "exchange" where they are obligated to insure each and every citizen, regardless of their condition, at something approaching relatively sane premiums.

At the same time, each and every citizen is obligated (hence the term "individual mandate) to sign up for health insurance, so they won't get tempted to sign up for a quick, free dip into the money pool just at the moment they get sick and subsequently screw other paying customers. Those who don't sign up by March 31, 2014 get hit with a penalty, starting at $95 or 1 percent of your taxable income, whichever's greater.

So I lose $95/year if I don't sign up. Big whoop.

$95 or 1 percent of your taxable income. You make $70,000/year? That's $700 you have to pay. And it gets worse. By 2015, the penalty grows to $325 or 2 percent of your taxable income. The year after and subsequent years, its $695 or 2.5 percent of taxable income.

But Mack! I don't even have a pot to piss in, let alone a window. How am I gonna pay for this shit?

You don't. At least if your income's below a certain threshold. In addition to the individual mandate, the Affordable Care Act also expands Medicaid coverage to include individuals age 19 to 65. That means those stuck below the federal poverty line can simply opt for Medicaid coverage. That is, if their state's playing ball.




Thanks to a U.S. Supreme Court ruling that mandated voluntary participation, 22 states have opted out or are leaning close to opting out of the federal government's Medicaid expansion through the ACA. That means if you make more than 100% of the federal poverty level, you can buy your health insurance coverage through the exchange for a significant discount. If not, you're left to the tender mercies of your state's income thresholds for Medicaid eligibility.

In the Great State of Alabama, the Medicaid income threshold for a family of three is $3,221. Per year. Make more than $3,221 but fall short of the $19,530 required to qualify for Obamacare? You're just about as screwed as the folks stuck in the Medicare Part D "doughnut hole".

Speaking of Medicare, the Affordable Care Act also unfucks a lot of what was wrong with it. For starters, enrollees get more preventative services (e.g. mammograms, colonoscopies, etc.) without paying extra. Enrollees stuck in the $2,970- $4,750 drug cost "doughnut hole" also receive a 50-percent discount when they purchase Part D-covered brand-name prescription drugs at the counter.

So why do guys like Ted Cruz treat Obamacare like the spawn of Satan and Grace Jones?

Because Tea Party?

But seriously, that's a good question that can only be answered with yet another lengthy and well thought-out blog post.

*Ba boom tish!

If you're one of the millions of unlucky bastards following the U.S. Supreme Court's ruling on the Affordable Care Act on CNN, you probably saw the following:


Turns out the reports of the individual mandate's death have been greatly exaggerated:

Correction: The Supreme Court backs all parts of President Obama’s signature health care law, including the individual mandate that requires all to have health insurance.

Watch live coverage and analysis of the pivotal decision, its impact on you and on the presidential race now on CNN TV, CNN’s mobile apps and http://cnn.com/live

In a race to break the story first, CNN tripped all over its half-tied shoelaces. Looks like it's time to invest in some Velcro slip-ons. H/T to Redeye.

Meanwhile, Jim DeMint is echoing a sentiment supposedly offered by Old Hickory himself:

“This government takeover of health care remains as destructive, unsustainable, and unconstitutional as it was the day it was passed, unread, by a since-fired congressional majority. Now as then, our first step toward real health care reform and economic renewal remains Obamacare’s full repeal, down to the last letter and punctuation mark.

“I urge every governor to stop implementing the health care exchanges that would help implement the harmful effects of this misguided law. Americans have loudly rejected this federal takeover of health care, and governors should join with the people and reject its implementation.”

It looks like states already have a roundabout way for opting out of ACA:

The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

State governors can opt out of Medicare expansion if it offends the sensibilities of their constituents, most of whom are a part of the one in four Americans who are currently without health insurance of any kind.

The next move for conservatives is to convince Americans that ACA, otherwise known as the semi-derogatory "Obamacare," is actually a tax on hardworking middle-class folk, 26,000 whom die annually without having any coverage. This way, conservatives can sell themselves the story of how Justice Roberts pulled off a clever end-run on the Obama administration:

The Supreme Court has upheld the Affordable Care Act. Chief Justice John Roberts has upheld the individual mandate. But not under the commerce clause. Instead, Roberts has said that the law can proceed under Congress’s ability to tax.

It’s a tax. That thing that Democrats were trying so hard not to do so Republicans couldn’t call Obama a “tax and spend” Democrat is now called a tax by the Supreme Court. And now it’s a victory. Until the GOP starts saying that Obama “raised your taxes.”

Americans really have little concept of how they pay taxes in the first place, why they should pay and how the tax brackets actually work. There's also the mostly-unspoken fear of how minorities are gonna steal everyone's tax monies and spend them on rims, fried chicken, lotto tickets and whatever else those people spend their money on. It's how the GOP can convince conservatives to vote against their interests (in the form of tax cuts for billionaires and corporations) and how these folks just can't connect the dots between their ridiculously low taxes and the growing number of potholes and dead street lamps on their block.

These same people want to keep anything approaching universal health from coming to fruition, yet continue paying private healthcare insurance providers thousands of dollars per year on coverage that might get dropped from under them if the provider thinks it'll put even a small scratch in their bottom lines. I don't like having the Emergency Room as my only option because it costs a significant part of my wages to be insured. Or because my insurer unceremoniously drops my coverage over a lifesaving procedure. Or because of "preexisting conditions" no one will touch with a ten-foot pole.

For anyone considering the ACA a sop to the healthcare industry (in the same way state-mandated auto insurance is to that industry), it'll seem that way unless enough people hop aboard the "Medicare for All" bandwagon to make that concern moot or unless the Obama administration finds a way to lower healthcare insurance premiums, the overall cost of healthcare or both.

Right now, there are 52 million Americans who do not have health insurance. An additional 73 million Americans have trouble paying for their health care, and 75 million deferred medical treatment because of it.

This is the story of one man who, like many Americans, didn't have health insurance. And it cost him his life.

Doctors at University Hospital in Cincinnati said a 24-year-old father died Wednesday from a tooth infection.

Patti Collins, wife of famed local musician Bootsy Collins, said she couldn't believe what happened to her nephew, Kyle Willis, who left behind a 6-year-old daughter.

"I said, 'What do you mean they're calling the family?' (My daughter) said, 'Mom, the infection (Willis) had in his tooth has gone to his brain," Collins said.

But doctors said that rare as it may be, what started out as a toothache eventually killed the young father and aspiring paralegal.

Family members said Willis' wisdom tooth started hurting two weeks ago. Dentists said it needed to be pulled, but being an unemployed single father, Willis decided to ignore the pain.

Collins said her nephew was out of work and didn't have health insurance.

In most cases, the only way Americans can get decent health benefits without paying an arm and a leg (pardon) for them is to find a job that offers health benefits as a perk. Like many Americans, I'm sure he lost whatever health benefits he had the moment he was laid off.

And like most Americans without health insurance, he had to wait until he absolutely had to go to the emergency room in order to receive treatment.

But when Willis started getting headaches and his face began to swell, he went to the emergency room.

"The (doctors) gave him antibiotic and pain medication. But he couldn't afford to pay for the antibiotic, so he chose the pain meds, which was not what he needed," Collins said.

Doctors told Willis' family that while the pain had stopped, the infection kept spreading -- eventually attacking his brain and causing it to swell.

"He should have gone to the dentist to take care of the toothache, and it wouldn't have escalated to this. It's a lesson learned by all," Collins said. 

Collins said the family wants to make sure what happened to Willis never happens to anyone else.
Family members said they are trying to get an account together for Willis' funeral expenses, and they're also hoping to create another fund for his daughter's college education.

This man will never get to see his daughter grow up, go off to college, start a career or start her a family of her own. And this man will never get to realize his goal of becoming a paralegal. A promising life lost and a family torn apart.

But wait...he's the nephew of Bootsy Collins' wife? Couldn't he have gotten his rich uncle to foot the medical bills?

It's a shame his uncle didn't come forward with a measley $20 when it would have saved his life.

Who knows what the family situation was like? I know family members who wouldn't piss on one another to put them out if they were on fire. Family dynamics are strange like that.

At some point, the comments were "cleansed" of the more "base" comments. And here's one such comment, in all it's epic glory:

Terrible, a dentist actually expects to get paid for their work? Horrible people, those dentists. ENTITLEMENTS that is what is wrong with the healthcare system, just like the rest of the country. Who is making money? The dentist down the street, or the MEGA Corp "insurance" company with it's skyscrapers? A good living, hopefully, vs dividends for shareholders. Quit blaming dentists for the troubles. How many smokes can you give up to get your teeth worked on? What about the stupid lotto tickets

Everyone complaining about dental "insurance" being hard to get, it is NOT insurance. It is a dental "benefit". It was not designed for people who don't take care of themselves. The max benefit is the same as it was in 1964 for most people. Benefit companies do everything they can to make sure you don't use it if you have it too. WHHHAAA, dentists are too expensive. You go to school, get the loans, risk your license on idiots all day, then see if you think it should be cheaper.

All the people who want the govt to be involved in their health are CRAZY. The govt has no interest in your health, just your votes. Healthcare reform won't fix stupid. This was just dumb, this is pure neglect, bad choices in life. Quit blaming everyone else for your bad choices. Sad he died, but no different than a grown man playing in rush hour traffic. It was bound to happen.

The guy had gold on his neck he could have pawned. He could have brushed and flossed like all of you SHOULD and he would not have had this happen. Quit trying to blame everyone else, he let it happen to himself. If he cared enough to spend ~$8 a month on his teeth (floss/paste/brush) and use them correctly, he isn't going to get this kind of thing happening. PERIOD. All the bellyachers saying I don't have any enamel/I have soft teeth too, GROW UP. No, breast feeding DOES NOT hurt your teeth.

The stupid, it burns.

Instead of treating universal health care as a preventative measure that not only saves lives, but also lowers the cost to taxpayers and businesses, it's deemed a "socialist/Marxist" invention used by limp-wristed socialist Europeans and Canadians, one that seeks to make doctors poor, bleed God-fearing taxpayers dry and keep welfare queens nice and healthy. And to die-hard conservatives, the fact that you don't have health insurance is a personal failing, therefore you deserve everything that happens to you.

These same people often have enough money to swing the thousands of dollars per year needed for health coverage or have the federal government take care of that (DoD/DoJ/government contractors). It's a case of "Got Mine, Fuck You" Syndrome.

It's too bad Obama passed that limp-wristed healthcare reform bill without including the public option. If it didn't help Kyle Willis in time, at least it would have helped so many other Americans currently without health insurance.